Spettroscopia nel vicino infrarosso (NIRS) e alterazioni dell’emodinamica cerebrale in corso di fibrillazione atriale

Abstract

The growing epidemiological burden of atrial fibrillation (AF) warrants urgent clarification of the mechanisms at the basis of the independent association between the arrhythmia and cognitive decline/dementia. Several mechanisms have been proposed, such as silent cerebral lesions (subclinical ischemia or micro-haemorrages), a chronic reduction in mean cerebral blood flow, AF-associated pro-inflammatory status and cerebral endothelial dysfunction. However, a new hypothesis based on computational da-ta has recently emerged, which claims that AF irregular rhythm itself may promote direct deleterious beat-to-beat effects, which translates into critical hemodynamic events in the distal cerebral circle. To overcome the limitations of the currently adopted techniques in the study of cerebral circle (transcranial Doppler and Arterial Spin Labeling MRI), we recently demonstrated that cerebral near-infrared spectroscopy (NIRS) with high sampling frequency (20 Hz) may provide beat-to-beat hemodynamic in-sights from the cerebral microcirculation, paving the way for the assessment of distal cerebral hemodynamics during AF. Should the computational findings be confirmed, it will be fundamental to evaluate whether the most aggressive rhythm control strate-gies (such as transcatether ablation) may contribute to reduce cognitive burden in AF patients.